Tag Archives: Population Health

Uncertainty. Opportunity. It’ll all be there for healthcare in 2017, PwC says

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http://www.healthcaredive.com/news/uncertainty-opportunity-itll-all-be-there-for-healthcare-in-2017-pwc-sa/432384/

You reap what you sow. The idea is the push behind countless movie plots and rock songs but it’s also a central theme to PricewaterhouseCooper’s (PwC) Health Research Institute’s (HRI) new report on healthcare trends to watch out for in 2017. The seeds for next year were planted in 2007, according to the new report.

There will be certain uncertainty over the fate of the Affordable Care Act next year. However, many of the trends that should be on top-of-mind for hospital administrators next year will relate to value-based care, Trine Tsouderos, PwC’s Health Research Institute director, told Healthcare Dive. “If you think about the political changes as the waves on the surface of the ocean, there’s a very strong current underneath that is the shift to value-based care,” she said. “We do not see that changing. We see the shift continuing industry-wide despite any changes in Washington, DC.”

For example, only 90 or so retail clinics were in operation and about one in 10 consumers have been to one in 2016. Today, more than 3,000 such clinics have been propped up across the U.S. with one in three consumers having visited one. This drift highlights the continued move to more convenience in healthcare access as well as price transparency for patients.

Sticking with the nautical theme, Tsouderos likened the healthcare industry to a battleship in explaining why ideas from 10 years ago are now coming to fruition. It takes a long time to change the course of such a large and complex ship. “You can’t turn [the industry] on a dime,” she said.

What emerging trends administrators should know for 2017

https://www.pwc.com/us/en/health-industries/top-health-industry-issues.html

 

Trend to watch: Payer-provider joint ventures

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Joint ventures are gaining steam as plans and providers look for ways to work together to provide higher-value care.

Anthem and Aurora Health, Anthem’s Vivity, Aetna’s Inova, Presbyterian Health Services in New Mexico, and now Aetna and Texas Health Resources—all of these organizations and partnerships combine the strongest skills of a payer and a provider.

These partnerships allow providers to lean on the analytical and actuarial power of the payers, while focusing on improving health outcomes.

CopelandAbout 13% of all U.S. health systems offer health plans, covering about 18 million members—or 8% of insured lives. according to a report from McKinsey & Company. Also according to the company, the number of provider-owned health plans is increasing about 6% each year.

Bill Copeland, vice chairman of Deloitte and leader of the company’s U.S. Life Sciences & Health Care industry group, says payers aren’t usually as effective as providers at working with patients, and providers don’t have the necessary capital to fully invest in high-value care. Joint ventures that marry the strengths of both parties have mutual benefit and should result in lower overall costs with better patient outcomes.

The top 5 conditions affecting communities, according to new BCBSA tool

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http://www.healthcaredive.com/news/blue-cross-blue-shield-health-index/431194/

Mapping technologies and population health make a beautiful pairing. Using geographical data can assist care delivery strategies as tech tools such as GIS can track and trend health data for a community overtime.

“As the move to accountable care and value-based payments takes hold, providers and health plans are increasingly interested in applying GIS to assess risk based on geography and the populations that live there, reveal where the greatest need is, and prioritize areas for interventions,” Danny Patel, account executive for health and human services at GIS software maker Esri, told Healthcare Dive in May.

While providers can look to reduce unnecessary readmissions using such efforts, plans like Blue Cross Blue Shield Association – which recently released its new BCBS Health Index – can use local health data to understand the health of a county/population. The tool, using blinded claims data from more than 40 million commercially-insured BCBS members, identifies the health conditions with the greatest impact on the commercially insured. The tool includes information on over 200 conditions.

“What the health index gives us is the ability to work with local stakeholders…to talk about where we need to focus broader health resources,” Maureen Sullivan, chief strategy and innovation officer at Blue Cross Blue Shield Association, told Healthcare Dive. She said the tool isn’t a “healthiest place to live” navigator but rather a starting point to understand conditions affecting communities and develop peer networks.

4 forces that will influence medical cost trends in 2017

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http://www.healthcaredive.com/news/4-forces-that-will-influence-medical-cost-trends-in-2017/421162/

The healthcare industry is in a transformational period. The rising use of retail clinics, MACRA, population health efforts and the Medicare Part B demonstration are but a few examples of disruptive conversations being had in board rooms. Yet, all of these discussions are underscored by the one topic underlying most business conversations: the almighty dollar.

There’s been plenty of digital ink given this year to the costs surrounding the industry. Just last week, a new Kaiser Family Foundation report outlined how the cost for the most popular ACA plan – the silver plan – is expected to rise on average 10-11% next year. Healthcare costs are generally expected to increase each year but, for context, the average silver plan increased an average of about 5% the previous year, according to the report.

However, a new PricewaterhouseCoopers’ (PwC) report stated while health prices are increasing, they are being tempered by the demand for value. PwC’s Health Research Institute (HRI) projects the medical cost trend – the projected percentage increase in the cost to treat patients from one year to the next – won’t increase or decrease next year but will stay the same as 2016: a 6.5% growth rate for 2017.

The report shows there’s a push and pull between healthcare services utilization and narrow networks focusing on value that could shift the medical cost growth rate in future years. “When medical growth outpaces general inflation, a flat trend is not good enough,” the report states.

“As a result, 2017 will be a tough balancing act for the health industry,” the report states, adding, “Healthcare organizations must simultaneously increase access to consumer friendly services while decreasing unit cost. Employers, worried that this current trend is at an inflection point that could turn back up, will demand more value from the health industry.”

HRI highlighted four factors that will influence the 2017 medical cost trend.

STDs Hit Historic High: CDC

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http://www.medpagetoday.com/InfectiousDisease/STDs/60900?isalert=1&uun=g885344d5310R7095614u&xid=NL_breakingnews_2016-10-19

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The number of cases of a sexually transmitted disease reported in the U.S. reached an all-time high last year, the CDC is reporting.

The combined total of reported chlamydia, gonorrhea, and syphilis cases was more than 1.8 million in 2015, the agency said in its annual Sexually Transmitted Disease Surveillance Report.

Those numbers are probably an underestimate, the agency said in a release, since most STD cases are undiagnosed and untreated. But the treated cases have reached an all-time — and expensive — high: the agency said it estimates the annual cost of therapy at nearly $16 billion.

The reported incidence of all three conditions rose from 2014 — by 5.9% for chlamydia, 12.8% for gonorrhea, and a whopping 19% for primary and secondary syphilis.

Healthcare Triage: Medicaid has a Huge Return on Investment

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Healthcare Triage: Medicaid has a Huge Return on Investment

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As we pass the 3-year anniversary of the opening of the insurance exchanges, most news seems to focus on the private insurance people can purchase there. In recent months, many have complained about private insurers exiting the exchanges, networks being narrowed, premiums rising, and competition dwindling out of existence.

But it’s important to remember that many, if not most, of the newly insured are part of the Medicaid expansion. As of today, 19 states have still refused to participate in that program. Some cite reports and news that Medicaid offers poor quality and little choice of providers. But most seem to cite the cost of Medicaid, claiming that its growing cost will eventually bankrupt states.

Such declarations only consider one side of the equation, though. In most ways, Medicaid offers an excellent return on investment. That’s the topic of this week’s Healthcare Triage.

Four areas of unnecessary senior healthcare

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http://managedhealthcareexecutive.modernmedicine.com/managed-healthcare-executive/news/four-areas-unnecessary-senior-healthcare?cfcache=true&ampGUID=A13E56ED-9529-4BD1-98E9-318F5373C18F&rememberme=1&ts=19102016

The number of seniors in the United States is projected to nearly double over the next 34 years—from 43 million in 2012 to nearly 84 million by 2050. During that time period, the number of seniors 85 and older is expected to jump from nearly 6 million to 19 million.

“Our Parents, Ourselves: Health Care for an Aging Population,” a report issued by the Dartmouth Atlas Project, a program of The Dartmouth Institute for Health Policy and Clinical Practice, also reveals that the number of seniors in Medicare private health plans such as Medicare Advantage increased from 6.4 million beneficiaries in 1999 to nearly 12 million in 2011—and that number continues to rise.

Because seniors are likely to experience frequent, complex interactions across many providers in the healthcare system, often there’s no single healthcare provider coordinating all of their care, according to the report, which was released in early 2016.

In addition, the American Geriatrics Society’s Choosing Wisely guidelines, which were released in 2013 and updated in 2015, provide geriatrics-specific recommendations to the American Board of Internal Medicine Foundation’s Choosing Wisely campaign. The campaign advances a national dialogue on avoiding wasteful or unnecessary medical tests, treatments, and procedures.

Here are four areas of elderly care—highlighted in the report and guidelines—that healthcare systems and health plans should be aware of to ensure that elderly patients aren’t receiving unnecessary care.

Editor’s Corner: Lack of preventive care in the US may hurt hospitals

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http://www.fiercehealthcare.com/finance/lack-preventative-care-u-s-could-wind-up-deeply-damaging-hospitals?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTlRSaU16TTJNREEwTUdZeSIsInQiOiJDTzgyZXFNZW1rc0hNb28wOE41R0hkcUVLSE9nb3pHemVGTFY0ZEJ0OFNkXC9UODNLaDNUYXRxR281Z2NMbWJET01wZGRlQ3FvNlFsSWJ1RHpVMjZKbmxoVHNMa1Y0b3ArNFRmbktOSUtvWm89In0%3D

Editor's corner

Bold statements are fairly rare from the heads of large hospital systems, but Robert Ostrowsky, the head of RWJBarnabas Health, made a pretty strong assertion in a recent interview with the Asbury Park Press: Hospitals should keep their communities healthy. But they don’t.

“It’s not easy because no one is willing to pay for that right now, meaning I don’t get reimbursed by insurance companies to keep somebody healthy and the government doesn’t seem to want to pay us to keep someone healthy,” Ostrowsky told the publication. “They all prefer to pay us when someone gets sick and they want us to spend less when that person is sick. That’s where the concentration has been. But an ounce of prevention. If they would take X number of dollars and say, ‘Here, use it to keep people healthy,’ actuarially, that will show you eventually spend less on sickness care.”

That needs to change for a variety of reasons that have begun to cascade into something profound. Princeton economist Alan Krueger has recently published a study (.pdf) showing a strong correlation between poor health and lack of workforce participation.

California Health Care Foundation – Regional Markets Issue Brief (June 2016)

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Click to access PDF%20AlmanacRegMktBriefSanDiego16.pdf

San Diego County circled on a mapCalifornia Health Care Foundation - Health Care That Works for All Californians

SAN DIEGO: MAJOR PROVIDERS PURSUE COUNTYWIDE NETWORKS and NEW PATIENT CARE MODELS

http://www.chcf.org/publications/2016/07/regional-market-san-diego

Is the CQO Position Needed?

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http://www.healthleadersmedia.com/quality/cqo-position-needed?spMailingID=9476343&spUserID=MTMyMzQyMDQxMTkyS0&spJobID=1000559816&spReportId=MTAwMDU1OTgxNgS2

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In a healthcare system’s most mature state, everyone owns quality,” says Baylor Scott & White Health’s chief quality officer. So if everyone owns quality, why have a CQO?